Monitoring in Anaesthesia Flashcards
Monitoring
Types:
List them
Continuous
Continual
Non-invasive
Invasive
Monitoring
Types:
• Continuous – __________________
Continual – __________________
• Non-invasive
Invasive
without any interruption
repeated at regular intervals
Standard for Basic Intra-operative Monitoring:
•Presence of ________________ throughout the procedure
•Evaluation of –
________,________,_______,________
•__________ & _________ monitoring
qualified anaesthetic personnel
Oxygenation
Ventilation
Circulation
Body temp
Clinical & Equipment
Resp Sys monitoring
Clinical
•Colour – _______
•Movement of _________
•Signs of __________
•Signs of __________
•Chest ________
•Chest ________
cyanosis
reservoir bag
obstruction; CO2 retention
excursion; auscultation
PULSE OXIMETER
• (Invasive or Non-invasive?) measurement of ________ in ________ blood. Also measures ________
• Differential wavelengths of _____ (______nm) and ________ (_______nm) light absorbed by ________-Hb & _____-Hb respectively.
Non-invasive ; O2 saturation
arterial; pulse rate
Red ; 660nm ; Infra- red ; 940nm
deoxy-Hb ; Oxy-Hb
Pulse oximeter
_____ emits light detected by ___________
LED
photo-detector diode
Pulse oximeter
The presence of well oxygenated blood → ↑ absorbtion of ______ light
• The presence of more de-oxygenated blood e.g. from difficult intubation, oesophageal intubation will absorb more _____ light
• The ______ calculates what is absorbed and produces a value for SpO2
IRed; Red
PDC
Pulse oximeter
During _______ blood is pumped into finger →↑ volume of finger demonstrated by the height of the ____________
Systole
plethysmograph
The pulse oximeter
Displays the ________ and ————- of the blood
•A probe is placed top to bottom over a digit from which light is emitted, absorbed and detected.
•May be inaccurate in some situations
pulse rate and oxygen saturation
Pulse oximeter
Pulse amplitude gives an indication of _____________
tissue perfusion
Accuracy of pulse oximeter affected by :
•____Hb (false ↑), ____Hb
•Position – _____,______,_______,_________
•Peripheral vaso_________
•Excess _________
•_______
• ______________
•↓↓ ______ states – hypotension, anaemia, hypothermia
•________ pulsation
Co; met
earlobe, bridge of nose, finger, toe
constriction; ambient light
Dyes; Coloured nail polish
perf; Venous
Pulse oximeter
Problems:
•Monitors ____________ but provides no direct info about ____________
•Response time of ____________.
•Cannot detect acute ______________.
•_______ or ____________ especially with long application on same site >______ in children.
O2 saturation ; O2 delivery
10 – 20 secs.
acute desaturation.
Burns or pressure sores
> 2 hrs
OXYGEN ANALYSER
•Essential to monitor __________ in gas mixture
FiO2
CAPNOGRAPHY
•Measures ________________ .
•Assesses ________________ of ventilation.
•Uses the principle of _______________
expired CO2 concentration.
adequacy
Absorbtion spectrometry
Capnography
principle of Absorbtion spectrometry –
Molecules with ___________________ will _____________ .
2 dissimilar atoms
absorb IR light.
Types of sampling
____stream
____stream
Main
Side
Clinical Considerations of capnography :
•Assesses __________ of ventilation
•Allows ventilation to be ________
•Measures __________
•Reliably identifies ___________________.
•Does not reliably detect ________________
adequacy ;modified
respiratory rate
oesophageal intubation.
endobronchial intubation
ETCO2
End tidal CO2
Normal ETCO2 = ???
3.5 – 5.7 kPa
Capnography
Phases of
Exp I – __________ gas
II – _______________________ gas
III – _________ gas
IV – _________
Phases of Exp I – Dead space gas
II – Dead space gas + alveolar gas
III – Alveolar gas
IV – Inspiration
Factors that increase ETCO2
•_________
•_____ventilation
•_______
•___________________
•_______ storm
ETCO2
•Rebreathing
•Hypoventilation
•Sepsis
•Malignant hyperthermia
•Thyroid storm
Factors that decrease ETCO2
____________
•____________
•____________
•_________ventilation
•________perfusion
•______thermia
•_______metabolism
Disconnection
•Cardiac arrest
•Pulm Embolism
•Hyperventilation
•Hypoperfusion
•Hypothermia
•Hypometabolism
Capnography tracings
____________-Elevated baseline FiCO2 is high – 1.6kPa
Rebreathing
Capnography tracings
•In rebreathing, ______ will be high – exhaustion of ______, ______ fresh gas
•In COAD – slow rising of ________, ________ is peaked
•In Recovery from NMB – patient gains ____________ and attempts __________ (___________)
FiCO2 ; soda lime
low ; Phase II, Phase III
spontaneous ability ;take a breath
curare cleft
Sudden precipitous fall in ETCO2 with ________ and _______
No ETCO2 with ______________
cardiac arrest disconnection
oesophageal intubation
O2 Failure warning device :
• _________ alarm of at least _____ decibels •Powered by _________ only.
•Cuts off _________ supply
•Open circuits to _________.
•Cannot be _________ or _________ until _________ is restored
Auditory ; 60 ; O2 pressure
anaesthesia gas ; atmospheric air.
switched off ; O2 supply
PRECORDIAL STETHOSCOPE
• Placed over the ______ side of the ______
•Confirms position of ______
Confirms ______ of ______
Assesses quality of __________
Assesses quality of ___________
Assesses ______ & ______
• Essential for ______ pts.
left ; chest
ETT ; adequacy of ventilation
breath sounds; heart sounds
HR & rhythm
paediatric pts.
Oesophageal stethoscope
Can incorporate –
•__________________
• __________
•______________
Temp probe (core temp)
ECG leads
Atrial pacemaker
Oesophageal stethoscope
Contraindicated in – _____________ or ____________
•Only used in ___________ patients.
oesophageal varices or stricture.
intubated
Cardiovascular System
•Clinical
________
__________
_____________
______________
Pulse
Heart sounds
Extremities
Urine output.
Cardiovascular System
•Clinical
Pulse – ____,______,_________
Heart sounds –_____,_________ esp in paeds
Extremities – warm, dry & pink, capillary refill
Urine output.
rate, rhythm, volume
rate, intensity
ELECTROCARDIOGRAM
•Monitors ____________ of the heart.
•Does not give any indication of ______
electrical activity ; CO
Electrocardiogram
•Uses
Determine _________
Diagnosis of ________, ________ conduction defect
Diagnosis of __________ _______
heart rate
ischaemia, arrhythmias
electrolyte imbalance
Electrocardiogram
_____ or _____ Lead configuration
Lead II – best detects _________
Lead I – best detects __________
3 or 5
arrhythmias
ischaemia
Electrocardiogram Inaccuracies :
•_____________ electrodes – should be over
________________.
•_________ contact – conductive gel b/w skin & electrode.
•Muscular activity e.g __________ , ↑ tone •____________ interference e.g ____\___
•Improper placement of ________________
electrodes ; bony prominences.
Poor skin; shivering
Electromagnetic interference ; diathermy
diathermy pads
ARTERIAL BLOOD PRESSURE
•Pulsatile arterial pressure due to rhythmic ventricular contraction.
•Reflects organ blood flow.
Sys BP
Diast BP
Pulse pressure = _______ -_______
MAP = ___________
SBP – DBP
MAP = DBP + 1/3 PP
Non-invasive Blood Pressure
• Relative C/I – site of ___________
vascular shunts
Non-invasive Blood Pressure
• Pneumatic cuff
• Palpable artery – usually ________
• Hg manometer/ aneroid gauge to display cuff press
__________________ – used in electronic devices
• Must be measured at least ______________
brachial
Oscillotonometry
every 5 minutes
Pneumatic cuff
Different cuff sizes- adult to neonatal (12cm std adult)
Occupy _____ of upper arm
Width of bladder –___________% > ———— of arm
________ of bladder over brachial artery
2/3
20- 50; diameter
Mid-point
Methods of detection of arterial blood pressure :
•__________ – no DBP or MAP.
•___________– of ________ sounds.
•__________
•_______________
Palpation
Auscultation; Korotkoff
Oscillotonometry
Plethysmography
Inaccuracies of arterial blood pressure :
•Over-reads BP with a _______ cuff, under- reads with _______ cuff.
•Atrial fibrillation and other arrhythmias
•Palpation difficult in _______ pts.
•Korotkoff sounds difficult to hear in _______ or peripheral vaso _______
small cuff ; large cuff
Obese
hypotension ; vasoconstriction
Invasive Arterial pressure
•_____________ in artery to provide beat-to-beat arterial press monitoring.
Catheter
Invasive arterial blood pressure
•Indications –
__________ hypotension
__________________ BP swings
_____________ disease
Need for _______ arterial blood gas sampling
Elective ; Large intra-op BP
End-organ; multiple
Invasive Blood Pressure
•Risk of arterial _________
• _______ Test is done to test adequacy of ________ collaterals
thrombosis
Allens; ulnar
Sites of Invasive blood pressure
_________ art.
_________ art.
_________ art.
________________
Sites
Radial art.
Brachial art.
Femoral art.
Dorsalis pedis
Complications of invasive blood pressure
____________
__________ / __________
__________, skin necrosis
________ damage
Inadvertent __________
•Complications –
Haematoma
Thrombosis / embolism
Infection, skin necrosis
Nerve damage
Inadvertent drug inject
CENTRAL VENOUS PRESSURE
•Cannulation of vein in ________ to
measure filling pressure of the _________.
•Reflects Blood volume (________), _____ heart function
thorax ; Rt atrium.
preload
right
CENTRAL VENOUS PRESSURE
•Indications-
Fluid mx in __________
_______ access
Infusion of ______ drugs
______________________
_________ of air embolism
hypovolemia
Venous; caustic
Total Parenteral Nutrition
Aspiration
Sites of Central venous Cannulation
Mention 4
Int Jugular
Subclavian
Femoral
Basilic
Central venous pressure
Measuring device:
_______________ (cmH2O)
_________________ (mmHg)
•Procedure
Aseptic.
Reqs _____ monitoring
•Normal value ___-____cmH2O
Water manometer
Pressure transducer
ECG
- 0 – 8
Urine Output
• _________ , _________ surgeries or if _________________ is anticipated
• Requires a urinary catheter
• Aim for ____ml/kg/hr
• Must be measured every _________
• Check that catheter is not _________ or _________
Major ; prolonged
significant blood loss is anticipated
1; hour
kinked or misplaced
Central Nervous System
DEPTH OF ANAESTHESIA
•Clinical
_______ stages of anaesthesia
Sympathetic stim – ___,_____,______,_______
Guedels
HR, BP, sweating, lacrimation
BiSpectral Index (BIS )
• to measure _____________________
• Combines _____________ and ______________ technology
• Electrodes transmit to the monitor
Depth of Anaesthesia monitor
Electro encephalography and Electromyography
Neuromuscular Junction
• Peripheral Nerve Stimulator
Assess ________ , ________, ________ or ________ response to electrical stimulus.
Use ________, ________ or ________ nerve
• Train of ________
visual, tactile, mechanical or EMG
ulnar, facial or tibial nerve
Four
Temperature
• ____________
•__________________thermometer
•Thermistor
•Infrared tympanic thermometer
Temperature
•Peripheral Skin temp – _________
•Core temp – _________, _________, _________, _________, _________, _________ (unreliable)
Peripheral Skin temp – axilla
•Core temp – lower oesophagus, tympanic membrane, nasopharynx, bladder, pulmonary
artery, rectum (unreliable)
Thermistor – incorporated into _______________, _______________
oesophageal stethoscope
Pulmonary artery catheter
BLOOD LOSS
•Clinical
Degree of pallor – _____________
___,_____,_________
____________
•Gravimetric
Blood in ________
________ of swabs – ____g = ___ ml.
mucous membrane
HR, BP, capillary refill
Urine output
suction bottles; Weighing
1;1
BLOOD LOSS MEAUSREMENT
MENTION 5
Clinical
Gravimetric
Colorimetric
Visual estimate
POC
BLOOD LOSS
Visual Estimate
___________ , surgical ___________, ___________, ___________
•Colorimetric
Measures ___________ in washed swabs &
drapes
Must know patient’s ___________
Can only be done at the ___________ of surgery
Suction bottles, surgical gauze, drapes, floor
Hb concentration ; pre-op Hb
end
Haemoglobinometer
A ________ device (portable device) that determines _______ at the bedside using a drop of blood.
point-of-care
haemoglobin
Essential Intra-operative monitoring
•Continuous presence of the ____________ .
•____________
•Continuous ____________
•Continuous ____________
•____________ alarm (if ____________ vent) •Continuous ____________
•BP at least every _________
anaesthetist.
O2 analyser; Pulse oximetry
Capnography ; Disconnection
mechanical ;ECG
5 mins
